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Diarrhoea and massive duodenal round cell infiltration in a 27-year-old HIV positive female
  1. Clemens Neufert1,
  2. Abbas Agaimy2,
  3. Jochen Wacker3,
  4. Helmut Neumann1,
  5. Markus F Neurath1,
  6. Martin Raithel1
  1. 1Medical Clinic 1, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
  2. 2Institute of Pathology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
  3. 3Medical Clinic 3, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
  1. Correspondence to Dr Clemens Neufert, Medical Clinic 1, Friedrich-Alexander-Universität Erlangen-Nürnberg, Ulmenweg 18, 91054 Erlangen, Germany; clemens.neufert{at}uk-erlangen.de

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Clinical presentation

A 27-year-old black female with recently diagnosed HIV infection (CD4+ T cells 9/μl; viral load >106 copies/ml) was admitted to the hospital with diarrhoea, malaise, weight loss and ‘heavy legs’. On clinical examination, the emaciated patient (body mass index 15.8) was in a compromised clinical condition with bilateral ankle oedema. Laboratory tests revealed several pathological values including low albumen 15 g/l (reference level: 34–48) and severe pancytopenia (haemoglobin 4.5 g/dl, reference 12–16; white blood cell count (WBC) 3.6/nl, reference 4–10, platelet count (PLT, 61/nl, reference 140–400). Mean corpuscular volume (MCV, 80.2 fl) was at the lower limit of the reference level (80–99).

Upper gastrointestinal endoscopy showed a striking picture …

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